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APPLICATION FOR 2008 ETCO EDUCATIONAL GRANTS

FORM 0 - PERSONAL DATA

Please fill in:

Personal Data Information :
 
Last Name:
 First Name:  
Business Address:
 Country:  
Postal Code:
City:  
Phone Number: Fax:  
Email:      
         
Professional Background (check one) :      
Medical Doctor  (MD)

Technician's degree

 
Diploma nursing (RN)

Bachelor's degree

 
Associate's degree

Other  

 
     

Specialty or Main work area: (check one)

   
Intensive Care

Anesthesiology

  
Emergency Services
Nephrology  
Surgery
General Practitioner  
Paramedic
Other    
Years of Transplant Coordinator experience :    

Primary place of employment (check one)

   
Private or government / military Transplant Hospital
 
University Transplant Hospital
Non-transplant Hospital  
Local or Regional Sharing Office
Independent OPO  
Supranational Sharing Office

National Sharing Office

 

Other  

     
         
I certify that the information I have submitted in this application is complete and correct to the best of my knowledge and belief. I understand that if the information I have submitted is found to be incomplete or inaccurate, my application may be rejected or my examination results may be delayed, not released, or invalidated by the ETCO-CCB. I also understand that the ETCO-CCB may confirm my eligibility for this examination or direct certification by verifying my academic/professional credentials and/or by contacting the employers listed.
 
         
Signature: Date :

 
         

Send this application with all the required documents to:
(fill the documents check-list included below)

ETCO General Secretary
Dr Luboslav Bena
CETC, MD

ETCO Executive Office
C/- Joan Maragall 12,
08360 Canet de Mar
Barcelona, SPAIN
Fax : 0034 937 942 658
E-mail: janealewis@gmail.com

  
    Maximum transfer files limit 800 Kb  
Certificate of present job as TC
Your CV
 
 
 
 
 
 
    

 

 
Executive Office Letter of the President Structure of Etco Committees Organs & Tissues
National Key Members Annual Meeting of ETCO Certification Future Congress Etco Board
Recommended Bibliography Donation Bibliography Transplantation Guidelines Future Events Congress in Prague 2007
Transplant Organizations Transplant Centers Europe Journals Transplantation Donation Forums Organ Procuremenet
Irodat 2005 Statistics Subscription Information Membership Application Sponsors Etco bylaws

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